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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600645
Report Date: 03/07/2023
Date Signed: 03/07/2023 01:59:25 PM

Document Has Been Signed on 03/07/2023 01:59 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:SCRIPPS RANCH SWIM & RACQUET CLUBFACILITY NUMBER:
376600645
ADMINISTRATOR:MONICA OATESFACILITY TYPE:
840
ADDRESS:9875 AVIARY DRIVETELEPHONE:
(858) 271-6222
CITY:SAN DIEGOSTATE: CAZIP CODE:
92131
CAPACITY: 66TOTAL ENROLLED CHILDREN: 66CENSUS: 0DATE:
03/07/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Monica OatesTIME COMPLETED:
02:10 PM
NARRATIVE
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On 3/7/23 at 1:30 pm, LPA Annette Sutherland made an unannounced CASE MANAGEMENT inspection, for reported Lead Exceedance. LPA met with Director, Monica Oates. There are no day care kids present. Day care hours are 2:05 pm - 6:30 pm. LPA interviewed director and examined the faucet deemed an Action Level Exceedance.

Faucet reported with 5.5 ppb or greater lead exceedance levels was as follow:

Lobby drinking fountain         13.00 ppb

Faucet in exceedance is a drinking fountain located in the facility lobby. Children in care are only in that area if they are doing homework 4:00 -4:45 pm . Facility has not used this fountain since Covid 2020. Children bring water bottles to facility each day and the facility provides filtered water to refill the bottles.  Director posted "Do Not Use sign" and will continue not to use until the drinkning faucet is fixed and retested.

See LIC809D for deficiency cited.

Exit interview conducted and report was reviewed with the Facility Director Monica Oates.
A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Annette Sutherland
LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 03/07/2023 01:59 PM - It Cannot Be Edited


Created By: Annette Sutherland On 03/07/2023 at 01:51 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: SCRIPPS RANCH SWIM & RACQUET CLUB
FACILITY NUMBER: 376600645

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/07/2023
Section Cited

101700.3(b)(1)

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101700.3(b)(1) Written Directives: A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.
This requirement is not met as evidenced by:
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Drinking faucet has not been used since Covid 2020. Facility will continue to not use drinking faucet untill it has been fixed and retested and results indicate it is below exceedance level. A sign "Not to use" is posted.
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Based on water testing results and interviews, facility tested over the Action Level Exceedance at one drinkning faucet. This poses an potential health, safety or personal rights risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Monica Cuddy
LICENSING EVALUATOR NAME:Annette Sutherland
LICENSING EVALUATOR SIGNATURE:
DATE: 03/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2023


LIC809 (FAS) - (06/04)
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